Sky's falling? No biggie

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When I joined this magazine 21 years ago, one of my first assignments was to cover a state convention. It was a real eye-opener.

Session after session talked about funding cuts, new regulatory burdens and a hardscrabble landscape for as far as the eye could see. It was sobering stuff. I couldn't help but wonder if this field was entering some sort of death spiral.

After a full day of listening to Chicken Little-like warnings, I walked to my car. It was a rusting, four-cylinder, manual-transmission number with a bad paint job, a broken antenna and no air conditioning. My friends lovingly referred to it as the “POS-mobile.” (Hint: The first two letters stood for “Piece of”). It was parked between two shiny black Lincoln Town cars. Each bore the logo of a nearby long-term care center.

My first thought was an obvious one: If these are the cars nursing home operators are tooling around in, how bad can things be?

In fact, both the dire predictions and the nice rides were hardly aligned with the reality many operators were experiencing. Most facilities were getting by on a combination of hard work, smarts and adaptability.

That's worth keeping in mind as things continue to unravel in our nation's capital. There's no doubt that the partisan divide between Democrats and Republicans is probably as goofy as ever. It's also becoming quite clear that public funding for healthcare and other services for the aged will be stressed as never before. And it hardly helps that the people tasked with finding solutions seem far more concerned with keeping their day jobs.

But here's the rub: Tough times are nothing new for this field. The nursing home sector got its start trying to fit into a regulatory structure designed for hospitals. Its largest funding source — Medicaid — is specifically restricted to the indigent.

Far too many states have told operators to make do on Medicaid payments that are far below the rates you'd find at almost any decent hotel.

Despite these and other challenges, operators have always shown remarkable resiliency. So I'm not terribly concerned about looming challenges. Most serious operators will find a way to compete and survive. At this point, it's pretty much second nature.
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